腹腔镜下经改良Prentiss路径睾丸下降固定术治疗小儿高位隐睾临床研究

Clinical study of laparoscopic testicular descent fixation via modified Prentiss pathway in the treatment of high cryptorchidism in children

目的:通过腹腔镜下经改良Prentiss路径高位隐睾下降术与未改良术式相比较,探讨其临床效果,评估其安全性和有效性。方法:选取我科2014年4月—2020年4月收治的132例144侧高位隐睾患儿,均一期行腹腔镜睾丸下降固定术,其中53例58侧采用未改良术式,79例86侧采用改良术式,比较两种术式的术后近远期效果及并发症情况。结果:所有患者均一期完成手术,两组手术时间及住院时间及术后一般情况比较差异无统计学意义(P>0.05);未改良术式组阴囊水肿、血肿,切口裂开及感染发生率为47%,改良组为6%;未改良术式组睾丸回缩发生率为45%,有2例患儿完全回缩至腹股沟管内,再次手术,改良组为3%,差异有统计学意义(P<0.05);术后患侧睾丸体积均较术前有增长,术后6个月未改良组睾丸体积为(0.34±0.14) mL,改良组睾丸体积为(0.38±0.15) mL,差异有统计学意义(P<0.05)。结论:腹腔镜下经改良Prentiss路径睾丸下降固定术减少切口裂开,阴囊肿胀等术后并发症,更重要的是降低了睾丸回缩的概率,利于睾丸生长,避免了二次手术的可能,值得推广。

Objective: To explore the clinical effect and evaluate the safety and effectiveness of modified Prentiss pathway compared with unmodified operation. Methods: From April 2014 to April 2020, 132 cases of 144 sides high cryptorchidism were selected. All of them underwent laparoscopic testicular descending fixation. Fifty-three cases were treated with the unmodified operation on 58 sides, while 79 cases were treated with modified operation on 86 sides. The short-term and long-term effects and complications of the two methods were compared. Results: All patients were completed the operation in one stage, and there was no significant difference in operation time, hospital stay or postoperative general condition between the two groups(P>0.05). The incidence of scrotum edema, hematoma, wound dehiscence and infection in the unmodified group was 47%, while 6% in the modified group. The rate of testicular retraction in the unmodified operation group was 45%. Two children were completely retracted into the groin canal, and operated again. The difference was statistically significant(P<0.05). The testicular volume of the affected side after operation increased compared with that before operation. Six months after operation, the testicular volume of the unmodified group was(0.34±0.14)mL, and that of the modified group was(0.38±0.15)mL(P<0.05). Conclusion: Laparoscopic testicular descent fixation via modified Prentiss path can reduce the postoperative complications such as incision dehiscence, scrotal swelling, and more importantly, reduce the probability of testicular retraction which is conducive to testicular growth, so that children can avoid the possibility of secondary surgery. It is worthy of promotion.